Lessons from the Future of the Electronic Health Record

Forecasts can be right and still not get the rate of change right or anticipate the profound implications of that change.

This futures lesson learned comes from watching the electronic health record move from possibility to probability to reality. 

By 2001 futurists definitely were including this forecast in healthcare futures research. Some likely were forecasting this before I tuned in. Five years later I watched an operating room nurse flip through a huge binder of medical records as she prepared my mother for surgery.  I quipped: “There’s no doubt we need electronic health records.”  She said, “In fact, I am on a team working on that here.”

At 10 years the electronic health record became the perfect illustration for how difficult it is to judge the rate of change in complex systems. Also a cautionary tale for those now caught up in the hype about autonomous cars. Yes, we will have them. When? See electronic health record.  

Finally a year ago the major health system where I get most of my healthcare put a system in place that works somewhat like futurists and thought leaders described 15 years ago.  Except I still have providers who are not part of this system. It’s great as long as I am seeing an Inova provider. That’s not the primary reason why healthcare organizations like Inova are caught up in a merger and consolidation frenzy, but it is an important market consequence.  

Which brings us to my second point: how profound the implications could prove.  In 2001 because my colleagues were researching the future of medical research, they heralded the potential to use health records to accumulate and analyze vast amounts of patient information. We do have research projects like that now, just not that many, because we still don’t have anything like the rich data sources my colleagues envisioned.

With the Affordable Care Act as a catalyst for healthcare reform, we are seeing far more anticipation of evidence-based care. How much of that evidence makes its way into the health record is no doubt the focus of countless hours of planning and development. The ACA dreamers are enthralled by the potential to use this data for coordination of patient care and pay for performance. 

This past month I have been scanning in areas that suggest two more profound implications we could see from analyzing patient outcomes.  

  • Today we rely on standards to design safe and effective medical devices. Someday healthcare delivery providers might rely more on outcomes data to determine which medical devices do make the most difference in healing patients and keeping them safe.
  • Today healthcare practitioners and employers rely on certification to demonstrate professional competence and ensure quality performance.  In the future outcomes data will be a much better quality indicator of performance than what someone knows. What we do matters more than what we know.

Healthcare associations with business models that rely on standards, certification and professional development should take note. The implications will be profound; we just don’t know when or in precisely what ways.  We are witnessing a profound systems change in slow motion. 

Some will act like this happened overnight, when it is taking at least two decades, and scramble for new strategic directions.  We need to get better at judging when something will occur and all that it might mean.